5 Shoe Lacing Techniques for Common Foot Problems with Dr. Jennifer Flo

Though foot anatomy can vary widely among individuals, we generally use a common approach to tie our shoes.

But there are actually more than 20 ways to lace shoes, and Dr. Jennifer Flo, a podiatric physician at Ankle & Foot Care Centers, recommends five specific techniques that accommodate different foot structures and can alleviate pain or discomfort.

“Individuals with a high instep, bunions, wide feet, pain in their toes or heel slippage can benefit from these different shoe lacing techniques,” said Dr. Flo. “Instead of getting rid of shoes that don’t fit comfortably, individuals can adjust the lacing and experience a difference in fit, providing better support and saving the cost of new shoes.”

Here are five common issues people experience and a shoe lacing solution for each. Watch the video to see Dr. Flo demonstrate each lacing modification style step-by-step.

1. Gap Lacing for High Instep

Side lacing begins with a normal criss-cross at the second set of eyelets and then skipping the next set, but keeping the laces on the same side and weaving through the fourth set of eyelets and then continuing with the criss-cross to the top. This way, the laces open up the middle of the shoe, but are still secured along the outside.

2. Increasing Forefoot Width for Bunions

Skipping the first set of eyelets at the forefoot allows for more breathing room toward the toes, taking pressure off of the bunions to prevent numbness and irritation.

3. Lock Lacing for Heel Rubbing/Blisters

Lock lacing utilizes the top set of eyelets (the two holes that are usually ignored), to secure a tighter fit around the top of the shoe and the ankle, preventing heel slippage.

4. Diagonal Toe-Cap Lacing for Toe Pain

If you start with the eyelet closest to the big toe and run the lace diagonally up to the last eyelet (closest to your ankle), and then take the other side of the lace back down to the other first eyelet and criss-cross regularly from there, the single diagonal stretch of lace from the first eyelet to the last will loosen the pressure toward the toes with a tug on the top of the lace.

5. Bar Lacing for Wide Feet

For bar lacing, start from the first set of eyelets with a criss-cross lace but skip a set of eyelets toward the center, to allow for more flexibility and breathing room.

Every Foot is Unique

While Dr. Flo recommends trying these different lacing techniques, she also points out that if at any point you have to strain to get your shoelaces tight enough to fit, the shoes are the wrong size and shape and you shouldn’t try to force them to fit.

For those who don’t have the mobility to tie their shoes, Dr. Flo recommends shoes with velcro or elastic draw string-closures, instead of slip-on shoes that lack support.

When looking to purchase shoes, be sure to choose a pair with eyelets that allow for lacing flexibility.

“Listen to your feet and find what works best for you,” said Dr. Flo. “If you have any questions about additional lacing techniques or other foot conditions, call your podiatric physician today.”

Click the image for a downloadable PDF.

3 Tips to Keep Your Feet Healthy this Winter

Wintertime in northeastern Ohio can present dangers to our foot health, but if we are aware of common conditions that result from this cold, wet season, we can prevent them with proper foot care.

Dr. Jennifer Flo, a podiatric physician at Ankle & Foot Care Centers, sees patients suffering frostbite, chilblains, fissures and injuries from slipping on ice. While some injuries are inevitable, Dr. Flo offers her patients the following tips for winter foot care.

1. Use Proper Footwear

Most foot problems that occur in the winter are a result of having cold, wet feet.

Dr. Flo’s top piece of advice is to keep your feet dry. She recommends wearing shoes or boots that are waterproof and have good insulation and will provide good traction. This will help to prevent your feet from getting wet and cold or from slipping on ice.

In addition to good shoes, you should wear socks that are made from 100 percent cotton or from a wool blend which will still allow sweat and other moisture to evaporate. A wool blend will keep your feet the warmest and Dr. Flo suggests wearing hunting socks if you plan to be outside for an extended period of time.

Socks made from synthetic fibers will hold on to the moisture and can lead to frostbite, blisters and chilblains, also referred to as pernio. Pernio are small lesions caused by inflammation of tiny blood vessels that results from exposure to moist, cool conditions, leaving irritated and itchy bumps or blisters on the toes that can be very painful.

Dr. Flo says to always keep an extra pair of dry socks nearby, whether you leave them in your car, your desk at work or your purse, as you never know when you might need them.

2. Use Moisturizers

Due to the lack of humidity and use of furnaces, our skin tends to become drier in the winter. This often leads to cracking of the skin, most commonly in the heels.

It’s important to moisturize your feet daily, especially when you notice cracking or fissures.

Dr. Flo recommends moisturizers that have the ingredient Urea, which helps to loosen dried skin and can help with the itching.

If you’re unaware of what lotion, cream or ointment to use, your podiatric physician can recommend off-the-shelf moisturizers or, in some cases, will provide prescription treatment.

3. Check Your Feet Daily

It’s common to forget to look at the bottoms of your feet, but Dr. Flo stresses the importance of giving yourself daily foot exams to help prevent any of these conditions in their early stages.

It’s especially important for individuals with diabetes who have weaker sensation and loss of feeling in their feet to do these daily assessments. Dr. Flo recommends using a mirror or having a loved one look at them if you are lacking mobility.

Frostbite, blisters and fissures can lead to worsening conditions such as wounds or infections, so it’s better to be aware and take a preventative stance than to deal with the problem after it occurs.

“Don’t neglect your feet,” said Dr. Flo. “They support everything we do, so it’s in our best interest to take care of them.”

How to Recognize, Prevent and Treat Diabetic Ulcers with Dr. Brad Backoff

If you have diabetes, you’re at risk for developing a diabetic wound. Podiatric physicians at Ankle & Foot Care Centers urge people with diabetes to stay on top of their foot health to avoid complications such as ulcers, which could develop into worse conditions if left untreated.

Dr. Bradley Backoff, a podiatric physician at Ankle & Foot Care Centers, says between 10 and 20 percent of diabetics experience a diabetic ulcer.

Dr. Backoff discusses what diabetic ulcers are, how they’re formed, how to recognize them early on and how to prevent and treat them.

What are diabetic ulcers?

A diabetic foot ulcer is an acute or chronic wound, which is a result of abnormal pressure and shear forces, generally found on the boney prominences of the foot.

“In addition to these forces, poor blood flow and neuropathy, a loss of feeling or sensation in the limbs, are thought to play a major role in decreasing the body’s ability to repair itself, contributing to the formation of an ulcer,” explains Dr. Backoff.

What are the risk factors, signs and symptoms?

In addition to diabetes, some common risk factors include decreased blood flow to the feet, neuropathy, abnormal foot structure, poor shoe selection, kidney problems, edema, which is the swelling of the legs and feet, and smoking.

A diabetic ulcer typically starts out as a callous, which forms as a result of a pressure point.

“Any diabetic with a callous, blister, or wound on the foot or leg should have it examined as soon as possible,” says Dr. Backoff. “Some other common symptoms individuals may notice are an increase in pain when they previously lacked sensation, a foul odor, or drainage in the socks or shoes.”

When left untreated, ulcers can lead to other complications, such as infection or the formation of an abscess, which is the collection of bacteria that requires surgical drainage. Another serious condition that can result is osteomyelitis, an infection of the bone. In the most serious cases, ulcers can lead to gangrene and the need for amputation of the lower extremities.

“Around 80 percent of amputations in the diabetic foot result from the presence of, or complications from an ulcer,” explains Dr. Backoff.

How do you prevent and treat ulcers?

Ulcers may be prevented by maintaining good control of blood sugars, wearing proper footwear, performing daily foot inspections and visiting a primary care physician and podiatrist on a regular basis.

“Diabetics should have a comprehensive diabetic foot exam to assess their foot health and determine their risk level,” says Dr. Backoff.

“Generally speaking, diabetic patients should see a podiatrist at least once a year, but patients who have a foot deformity, neuropathy, or peripheral vascular disease are at risk for ulcers, and should be seen more often.”

Ulcers are treated with a combination of local wound care and offloading, which refers to taking weight off the pressure points by placing an individual in a special shoe, boot, cast or bandage.

Vascular surgery may be necessary if the blood flow is poor and prevents the ulcers from healing. If there is an active infection, antibiotics, or in severe cases, amputation, may be necessary.

“Staying informed and aware of one’s health and seeking out treatment is the best thing anyone can do, but especially diabetics who are at risk for ulcers and other serious complications. Awareness is crucial for prevention of conditions associated with diabetes.”

Foot and Ankle Sports Injury Prevention with Dr. Kwame Williams

Whether you take part in regular exercise or play intramural or competitive sports, athletic-related injuries can be common if proper care is not taken, says Dr. Kwame A. Williams, a podiatric physician at Ankle & Foot Care Centers.

Dr. Williams specializes in sports medicine and often treats patients for injuries related to overuse, lack of stretching or improper support, which he says can be avoided with proper care.

There are two major areas of injuries, which often occur simultaneously: soft-tissue injuries and bone injuries.

Soft Tissue Injuries

Injuries of the muscles, tendons and ligaments can occur due to micro-trauma, which is a result of overuse, or from sudden impact, twists or falls, known as macro-trauma.

Micro-trauma soft tissue injuries. Often times, when individuals exercise they don’t allow for enough recovery time in between workouts, causing tightness, tenderness and pain.

“Also referred to as repetitive micro-trauma, overuse injuries are common in high school and college athletes who are likely to over-train,” said Dr. Williams. “We also see this a lot at the start of conditioning or training, as a result of rushing into the movements and increasing the intensity too rapidly.”

Micro-trauma can cause tears or sprains in the connective tissues, as well as over-stretch the tendons, often resulting in swelling and discomfort.

Dr. Williams often treats athletes with plantar fasciitis and/or Achilles tendonitis, which is the swelling of tissues and tendons.

Macro-trauma soft tissue injuries. Sprains and strains are common macro-trauma injuries, caused by sudden impact.

Ankles and knees take on extreme pressure during sports and can result in differing degrees of tears to the ligaments (sprains) or injuries to the muscles and tendons (strains).

“Contact sports put athletes at risk for high-impact injuries,” said Dr. Williams. “But so do sports involving sudden starts and stops, such as track, cross-country or basketball” said Dr. Williams.

Similar to soft tissue injuries, bone injuries can also result from overuse and pressure, or from high impact trauma.

Bone Injuries

Bone injuries occur in every sport, not just contact sports, from repetitive trauma or sudden impact.

Micro-trauma bone injuries. Two of the most common lower-extremity bone injuries caused by overuse are stress reactions and stress fractures.

Stress reactions occur prior to a stress fracture, when the bone structure breaks down and becomes weaker.

Stress fractures occur when small cracks begin to form in the bone, and can result from over-use or not wearing proper shoes.

“Stress fractures are common in runners, who are often increasing their mileage each week, or are switching from running trails to pavement to grass,” said Dr. Williams.

Macro-trauma bone injuries. Similar to high impact trauma on soft tissue, bone injuries occur as a result of a fall, twist or some form of contact.

They also can eventually turn into a macro-trauma injury if not treated early. Broken bones are often a result of hairline fractures left untreated.

Fortunately, there are several ways to prevent and/or treat soft-tissue and bone injuries.

Tips for Prevention/Treatment

  • Proper shoe wear: Athletes should wear supportive shoes that are designed specifically for the sport. Shoes are built to take on different levels of impact and provide support and cushion in different spots. When evaluating shoes for impact sports, the best are wide, stabilized straight-lasted shoes, which are heavier and provide more support under the arch.
  • Stretch, warm up, vary exercises: Overuse injuries are often a result of not stretching enough before and after exercising. Athletes should warm up their calves and hamstrings prior to exertion and increase their heartbeats prior to a practice or game, says Dr. Williams. He also encourages athletes to vary their workout routines, so the body is not taking the same impact over and over again.
  • Custom orthotics: Custom orthotics are inserts that are designed to fit the shape of the foot and provide extra support. They can be worn in athletic shoes and everyday footwear.
  • Compression stockings: The gentle squeeze of compression stockings allows blood to flow up your legs and reduces swelling. “Compression stockings are the “best anti-inflammatory in the world,” says Dr. Williams.

These simple strategies can prevent a lot of injuries caused by stress, pressure and the pulling and pushing of the soft tissues and bones.

“If you feel any sort of pain or discomfort, allow your body to rest,” says Dr. Williams. “Listen to your body and if the pain persists, get checked out by your podiatric physician.”

Early Treatment Can Limit Impact of Peripheral Arterial Disease

April marks Foot Health Awareness Month and Ankle & Foot Care Centers is spreading awareness of peripheral arterial disease (PAD), which affects more than 18 million people in the United States.

PAD is a vascular disease caused by plaque build-up and the hardening of arteries, limiting blood flow to the legs and feet.

Dr. Mark S. Smesko, a podiatric physician with Ankle & Foot Care Centers, warns his patients to be aware of some common symptoms of PAD because it is crucial to seek early treatment and implement a prevention plan.

Symptoms of PAD

 “Patients with PAD can experience pain, numbness, burning in the legs and feet, cold toes and feet, loss of hair growth on the lower legs and feet as well as wounds on the lower limbs that won’t heal,” Dr. Smesko says. “People with PAD may also experience a condition called intermittent claudication, which is when they get extreme cramping in their legs and feet with activity, forcing them to have to sit down. They can get this from walking just a short distance.”

In more progressive cases of PAD, patients who experience intermittent claudication might also have rest pain.

“Patients can experience rest pain at night, due to a lack of blood flow while laying down,” Dr. Smesko explains. “They have to sit up, stand up and move around to improve blood flow back to the extremity. Rest pain is a sign of more severe disease than intermittent claudication.”

Common Risk Factors

 Individuals with diabetes are more at risk to experience PAD, Dr. Smesko warns.

“One in three patients who have diabetes and are over age 50 are likely to have PAD,” says Dr. Smesko. “A patient with both diabetes and PAD has a ten times greater risk for amputation.”

Other risk factors include smoking, hypertension, kidney disease and increased age.

Prevention and Treatment

Dr. Smesko recommends those at risk to manage their diabetes, get annual foot exams, stop smoking, keep blood pressure under control and stay active.

“If a patient has clinical signs of PAD, I order an arterial exam. This is a noninvasive test that detects blood pressures and wave forms at various levels of the leg, ankle and feet,” says Dr. Smesko. “If that comes back abnormal, I refer the patient to a vascular surgeon for evaluation and treatment.

“Sometimes patients with PAD may end up finding out they also have cardiac issues. About 60 percent of patients with PAD also have coronary artery disease. Therefore, it is crucial for individuals to seek treatment early, as soon as they experience any symptoms.”

# # #

Peripheral Arterial Disease Questionnaire

If you answer Yes to the questions below, you may be at risk for vascular disease. If you or someone you know may be at risk for PAD, contact one of our 20 locations today and make an appointment with a podiatric physician.

Do you experience any pain while at rest in your lower leg(s) or feet?

Yes   No

Do you have foot, calf, buttock, hip, or thigh discomfort (aching, fatigue, tingling, cramping or pain) when you walk, which is relieved by rest?

Yes   No

Do you have an infection, skin wound, or ulcer on your feet or toes that is slow to heal (8-12 weeks)?

Yes   No

Do you have high cholesterol level or other blood lipid problem, or do you take medication to lower your cholesterol?

Yes   No

Do you have high blood pressure or take medication for high blood pressure?

Yes   No

Do you have diabetes?

Yes   No

Have you ever smoked?

Yes   No

Have you previously had a stroke?

Yes   No

Do you have heart disease?

Yes   No

Do your legs hurt at night?

Yes   No

To stop the pain, do you hang your legs over the side of the bed?

Yes   No

Do you raise your legs to stop them from hurting?

Yes   No


Watch for These Common Foot Problems in Children

Children are affected by many of the same foot problems adults experience, including flat feet, plantar warts, ingrown toenails and heel pain. Some conditions occur more commonly in kids and are affected by their active lifestyles.

“I sometimes see toddlers because parents are concerned about the way their children are walking,” says Dr. Mark Smesko. “The majority of children are flat footed and toe walkers. I do exams, watch them walk and most times there are no issues. Some may need orthotics in their shoes to realign their feet. On a rare occasion, there may be a problem with a child’s knee or hip that may need to be referred to a pediatric orthopedic specialist.”

The following conditions are common in children.

Plantar Warts

Plantar warts can occur at any age but are very common in children. Caused by a virus, some warts respond to topical acid treatment but most need a laser procedure to eradicate the problem.

“I perform a laser procedure on most warts,” Dr. Smesko said. “This is great for kids because no anesthesia is required. So there is no shot, no wound and, most times, the child can resume activities on the same day.”

Ingrown Toenails

An ingrown toenail occurs when the edge of the nail, usually on the big toe, grows into the skin. This results in pain with activity and shoe gear and can lead to infection.

Often times this problem is hereditary in nature.

“I see quite a few kids with ingrown nails,” says Dr. Smesko. “If there is an infection present, an oral antibiotic is prescribed prior to any procedure. Once the infection is calmed down, I most commonly perform an in-office procedure under local anesthetic to remove the offending nail border.

“Then I use a chemical to kill the root of the nail so that portion of nail does not grow again. Less than 10 percent of the time does that side of the nail grow back after this surgery. Most times, the child can return to all activities after a few days.”

Heel Pain

Heel pain is another ailment that affects kids, most times between the ages of 8 and 14. With kids becoming more active year round in athletic activities, heel pain is becoming more common.

“I commonly see kids who go from one sport to the next, 12 months out of the year,” Smesko states. “Most heel pain is due to Sever’s disease, which is also called Calcaneal Apophysitis.

“As kids get bigger and more active, they put more stress and strain on their bodies. It is common for the growth plate of the heel to become sore and inflamed.”

The growth plate in the back of the heel attaches to the Achilles tendon as well as to the plantar fascial ligament. Tight calf muscles and overuse result in pain.

“The treatment for this consists of activity modifications, stretching exercises and support for the foot,” says Dr. Smesko. “Orthotics are commonly used as well as physical therapy in some instances. In severe cases, the child may need to stop playing sports and other activities for several weeks to calm down the pain.”

While most kids are active and healthy, certain foot issues will not get better on their own. If your child has any of these problems, please contact one of our offices to make an appointment.

Orthotics: A Non-Surgical Solution for Heel Pain

Among the most effective treatments for heel pain is the use of custom-made orthotics, which are foot supports worn in shoes and designed to alleviate pain by supporting natural foot movement.

Orthotic technician Tina Adkins helps set patients up with custom orthotics that can alleviate heel pain.

Many individuals suffer from pain in the heel, knee and lower back and may not realize their pain can be caused by poor foot function. Orthotics provide a non-surgical way to realign the foot and ankle bones to their neutral positions and decrease abnormal motion and pressure.

Tina Adkins, an orthotic technician, has been working with orthotics in Ankle and Foot Care’s diagnostic center in Boardman for over 13 years. She and her colleagues work closely with physicians in a regular process for fitting patients with custom-made orthotics.

A physician will decide if an orthotic device is necessary for a patient.  After Tina receives the patient’s prescription, she starts the fitting process, which is a 45-minute evaluation with the patient.

First, the patient walks in front of her so she can see if there is any noticeable abnormal movement of the feet, such as rolling inward or outward.  (Sometimes the scan doesn’t pick up what the eye can see, she explains.)

Next, the patient walks on a mat that performs a scan of the feet and creates a graph on Tina’s laptop.  The graph shows pressure points in certain parts of the foot, as well as other abnormalities. Tina can then design the fit for the custom orthotics right from her computer.

The orthotics arrive within a couple of weeks and the patient goes in for a final fitting with a physician or licensed orthotist.  He/she leaves the appointment with the foot scan and the custom-designed orthotic device.  If patients do not feel 50 percent better within 3-4 weeks, they are told to come back into the lab so technicians can readjust the orthotics.

Patients can choose among many different kinds of orthotics designed specifically for athletic shoes, work boots, dress shoes or everyday shoes.  One of the newest designs, referred to as the “cobra,” is shaped like a snake with the heel cut out, so that it can fit into a high heel shoe.

Orthotics can also come with heat-resistant material that decreases sweating or silver that decreases smell.

foot scan
This patient had heel pain in her right foot and was rolling on the outside of the foot to compensate, the foot scan shows.

“We have orthotics for everyone,” Tina says, as she explains the difference between orthotics for soccer, football, golf and even hockey.  “There are even orthotics that are waterproof.”

Tina sees about eight patients a day, all with different kinds of pain, but plantar fasciitis and heel pain tend to be the most common.

If you have serious pain or discomfort, schedule an appointment with a foot and ankle physician. He or she will examine your feet and ankles and suggest activity or treatment to improve comfort and function, including custom-made orthotics if appropriate.